Update on congenital glaucoma

Abstract

Congenital glaucoma is a global problem and poses a diagnostic and therapeutic challenge to the ophthalmologist. A detailed evaluation under general anesthesia is advisable to establish the diagnosis and plan for management. Medical therapy has a limited role and surgery remains the primary therapeutic modality. While goniotomy or trabeculotomy ab externo is valuable in the management of congenital glaucoma, primary combined trabeculotomy–trabeculectomy offers the best hope of success in advanced cases. Trabeculectomy with antifibrotic agent and glaucoma drainage devices has a role in the management of refractory cases, and cyclodestructive procedures should be reserved for patients where these procedures have failed. Early diagnosis, prompt therapeutic intervention and proper refractive correction are keys to success. Management of residual vision and visual rehabilitation should be an integral part of the management of children with low vision and lifelong follow-up is a must.

Illuminated Microcatheter Circumferential Trabeculotomy Versus Combined Trabeculotomy-Trabeculectomy for Primary Congenital Glaucoma: A Randomized Controlled Trial

“…Male predominance has also been reported from other studies in India (56%-64% male). 2,5,6,10 This is in contrast to the Western literature, which shows lack of sex predilection. 17,18 Family history of glaucoma in siblings was elicited in 2 patients (6.67%).…”

“…This is the preferred surgical procedure for the treatment of primary congenital glaucoma across most centers in North India as well as over the world, 6,8 although Mandal and associates have demonstrated good outcomes using combined trabeculotomy-trabeculectomy without using mitomycin C for primary congenital glaucoma. 5,6,10,16 In our series of primary congenital glaucoma, a predominance of male population was seen. Male patients constituted 73% and female patients were 27%, the ratio of male to female being 3:1.…”

“…8,9 However, the long-term complications associated with the use of mitomycin C and the presence of a filtering bleb can sometimes be sight threatening. 9,10 To overcome the limitations of conventional surgeries, circumferential (360-degree) trabeculotomy was described, initially using a suture. 11 However, this procedure had a risk of misdirection of the leading end of suture into the subretinal or suprachoroidal space.…”

Glaucomics: A Call for Systems Diagnostics for 21stCentury Ophthalmology and Personalized Visual Health

“…Two most common types are primary open angle glaucoma typified by a slow and insidious onset and agedependent increase in incidence, and angle closure glaucoma typified by a more acute course and higher prevalence in Asian populations. Primary congenital glaucoma is an autosomal recessive childhood glaucoma and accounts for 0.01%-0.04% of global blindness (Mandal and Chakrabarti, 2011). …”

A refresher relating to open and closed angle glaucoma

“…The syndrome is an autosomal recessive developmental disorder [17]. It is corrected by microsurgery or by eye-drop therapy using beta-blockers or prostaglandins [18].…”